In the Public Interest

Over the past several years, mental health has received almost unprecedented attention from the highest levels of government, ranging from the White House to the Surgeon General's Office. Yet the good things that happened or were intended to happen for people with serious mental illnesses have been derailed by the unintended consequences of first deinstitutionalization and then managed care. But despite this attention, care for the mentally ill has been moved near the bottom of the national priority list.--

In 1999, the Surgeon General's Office raised the national awareness of the plight of the mentally ill by issuing "Mental Health: A Report of the Surgeon General." The report sought to inform the public about the state of research, prevention and treatment on the mental and emotional disorders of children, youth and adults. The report also addressed barriers to care, such as stigma, accessibility, availability and cultural issues, that influence use of the mental health system. A supplement to the report, "Mental Health: Culture, Race, and Ethnicity," raised pervasive social and professional issues that limited the accessibility of the system for persons of color. Both documents aimed to raise the nation's awareness of mental health by placing it within the health arena, describing effective treatments for adults and children, addressing the shortage of providers, and once again highlighting the role of stigma in accessing care.

The most recent development in the mental health arena, of course, is the one that emanated from the White House. In early 2002, President Bush created the New Freedom Commission on Mental Health. Of the 15 members appointed, three were psychologists.

The commission

Unlike the Surgeon General's activities, which were primarily to inform, educate and raise awareness, the commission was given a far-reaching charge "to conduct a comprehensive study of the United States mental health service delivery system, including public and private sector providers, and to advise (emphasis mine) the President on methods of improving the system." The commission was also directed to look at quality and effectiveness of providers, identify innovative mental health services, and recommend needed modifications to the system. In two years!

After the first year, the commission issued an interim report that advised the president that the system was "in shambles," which was no surprise to the families and advocates of people with mental illnesses, but it was a pleasant surprise to see it stated in a government document.

The final report of the New Freedom Commission on Mental Health, "Achieving the Promise: Transforming Mental Health Care in America" was issued this year. Rather than dwelling on the fragmented and disorganized state of the nation's mental health system, the report outlines six goals and 17 recommendations for the president to consider. For example, in order to meet one goal of raising national awareness of the important link between mental health and overall health, the commission suggests that the government implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention. The final report also urges that the health system address mental health with the same urgency as physical health.

What next?

It is difficult to know what will happen with the commission's report. Obviously, the president is occupied with matters of national security and international policy at this time, but is likely to consider the report in due time. However, using the commission report as a starting place, consumer, family and professional groups such as APA might use the time to coalesce around agreed upon goals and begin to build congressional support for them.

Or, because mental health is really the province of the states--a goal not stated, but perhaps implied--a partnership between the states and federal government that would fund and maintain national standards of care could be a worthy use of time and resources. Perhaps the Federal Interstate Highway system could serve as a model. The Interstate system that exists today provides a smoothly coordinated system of super highways that replaced a state-by-state jumble of haphazardly connected roads and trails. A mental health system constructed on such a model would smooth many of the system bumps experienced by consumers and their families as they seek services.

Whatever happens next, psychologists and APA should be in the room when the decisions are made. That would certainly be in the public interest.